Overweight and obesity on the island of Ireland: an estimation of costs

Objectives The increasing prevalence of overweight and obesity worldwide continues to compromise population health and creates a wider societal cost in terms of productivity loss and premature mortality. Despite extensive international literature on the cost of overweight and obesity, findings are inconsistent between Europe and the USA, and particularly within Europe. Studies vary on issues of focus, specific costs and methods. This study aims to estimate the healthcare and productivity costs of overweight and obesity for the island of Ireland in 2009, using both top-down and bottom-up approaches.

Methods Costs were estimated across four categories: healthcare utilisation, drug costs, work absenteeism and premature mortality. Healthcare costs were estimated using Population Attributable Fractions (PAFs). PAFs were applied to national cost data for hospital care and drug prescribing. PAFs were also applied to social welfare and national mortality data to estimate productivity costs due to absenteeism and premature mortality.

Results The healthcare costs of overweight and obesity in 2009 were estimated at €437 million for the Republic of Ireland (ROI) and €127.41 million for NI. Productivity loss due to overweight and obesity was up to €865 million for ROI and €362 million for NI. The main drivers of healthcare costs are cardiovascular disease, type II diabetes, colon cancer, stroke and gallbladder disease. In terms of absenteeism, low back pain is the main driver in both jurisdictions, and for productivity loss due to premature mortality the primary driver of cost is coronary heart disease.

Conclusions The costs are substantial, and urgent public health action is required in Ireland to address the problem of increasing prevalence of overweight and obesity, which if left unchecked will lead to unsustainable cost escalation within the health service and unacceptable societal costs.

Linking Family Engagement with a Rights Perspective: Macro Factors Influencing Practice

While child welfare practitioners in many countries are struggling to develop methods of effective family engagement, they operate within different national and cultural contexts which influence, both positively and negatively, the ability to engage with families. Increasingly, international comparisons are necessary to further understanding of the development of social work practice. This is particularly necessary because most countries utilize international frameworks (such as the United National Convention on the Rights of the Child) to provide guidance in the development of policies, programs, and interventions. Each country (and locality) struggles to advance practice to be more effective and humane. Our paper offers a comparative analysis focused on family-oriented and rights-based frameworks of different countries. Based on a review of current national policies and a review of the literature regarding family based practices, we examine similarities and differences among four countries: the United Kingdom, Sweden, the United States, and South Korea. These countries were selected because they have some similarities (advanced industrialized democracies, professional social work, formal child protection systems) but have some differences in their social welfare systems (policies, specific practices, socio-cultural context). These differences can be utilized to advance understanding regarding the promise and potential for family engagement strategies. We then discuss the utility of this comparison for theory-building in the arena of child care practice and conclude by identifying the challenges and limitations of this work.

Parents' Views on Social Work Interventions in Child Welfare Cases

This article reports the findings of the third part of a three-part research project examining the potential for social workers to shift from a child protection to a child welfare orientation in their practice. Whilst social workers in the United Kingdom have been encouraged to make such changes they have been hampered by concerns to manage risk. Findings from the first two parts of the project had indicated that there was potential for a substantial proportion of child protection work to be redesignated as child welfare work, but that were this was achieved in practice there was evidence of continued influence of child protection processes as social workers sought to manage the risks inherent in child welfare cases. The study reported here sets out to ascertain the views of parents who were subject to child welfare interventions. The findings indicate that while parents feel apprehension with regard to contact with social workers, in the majority of cases successful relationships are formed. It is argued that social workers display considerable skill in monitoring potential risks whilst engaging with families and that the subtleties involved in such activity are not captured by official measures of governance which concentrate on more abstract indicators of performance.

Child Welfare Interventions: Patterns of Social Work Practice

Some 10 years ago one of the authors embarked on a research study examining the potential for social workers to shift from a child protection to a child welfare practice orientation (Spratt, 2000; 2001; Spratt and Callan, 2004). The research reported here develops that work; examining how social workers respond to ‘child care problems’ (CCPs). The results indicate that Northern Irish Health and Social Services Trusts (equivalent to Local Authorities in England and Wales) have responded to social policy goals to balance the protection of a lesser number of children whilst meeting the welfare needs of the greater by reducing the number of referrals designated ‘child protection investigations’ (CPIs) and increasing the number of CCPs. Closer analysis reveals, however, that a filtering system has been developed by social workers to address perceived child protection risks within CCP cases. Paradoxically, this leads to early closure of the more concerning cases, with service provision largely confined to the least concerning. The authors argue that the ways in which social workers balance social policing and supportive functions in practice may indicate possible responses to an increase in referred families anticipated within Every Child Matters (Chief Secretary to the Treasury, 2003).

Influence of social status on the welfare of growing pigs housed in barren and enriched environments

One hundred and twenty-eight pigs were reared in barren or enriched environments from birth to slaughter at 21 weeks of age. Pigs remained as litter-mate groups until 8 weeks of age when they were mixed into groups of eight animals. These groups were balanced for gender and weight and contained two pigs from each of four different litters. Each pig was assigned high or low social status on the basis of relative success in aggressive interactions at mixing. Injury levels were assessed on a weekly basis from 8 to 2 1 weeks of age. Pigs were exposed to two group food competition tests after a period of food restriction at 10 weeks of age, and to an individual novel pen test at 11 weeks of age. Behavioural and plasma cortisol responses to both types of test were recorded. Low social status was associated with increased injuries to the head, neck and ears, and therefore reduced welfare. Pigs with low social status showed reduced resource-holding ability in the food competition test, and greater avoidance of a novel object during the novel pen test. It is suggested that avoidance of the novel object reflected 'learned' fearfulness in these individuals. Environmental enrichment did not negate the effect of low social status on injury levels, but did appear to reduce the negative influence of low social status on stress during food restriction, and led to a reduction in fearfulness in response to the novel pen test. These results suggest that environmental enrichment may improve the we/fare of growing pigs with low social status.

Influence of social status on the welfare of sows in static and dynamic groups

Forty-eight Large White x Landrace multiparous sows were mixed into twelve groups of four animals after their piglets were weaned. These groups were defined as static, with no animals being added to or removed from the groups after their formation. Aggressive and submissive behaviours were recorded continuously for 9 h after the sows were mixed, and the sows were assigned high or low social status on the basis of their relative aggressiveness and success in aggressive interactions. After five weeks, each static group was mixed into a dynamic group of 40+/-2 sows for an 11-week period. Three static groups (ie 12 animals) at a time were added to the dynamic group at three-week intervals; the same number of animals was removed at these time-points in order to maintain the group number at 40+/-2. Injury levels increased significantly with the transition from static groups to the dynamic group (P

History of Child Welfare and Protection Social Work in Northern Ireland: Finding Continuity amongst Discontinuity in Case Files from 1950-1968

This article reports on research carried out on 200 child welfare files from the largest welfare authority in Northern Ireland from 1950-1968. The literature review provides a commentary on some of the major debates surrounding child welfare and protection social work from the perspective of its historical development. The report of the research which follows offers an insight into one core, and less well-known period of child welfare history in Northern Ireland between the two Children and Young Persons Acts (1950 & 1968). Using a method of discourse analysis influenced by Michel Foucault, a detailed description of the nature of practice is offered. This paper is offered as a work in progress, with further work being planned for dissemination of more detailed analysis of the method and outcomes. The research seeks to ask a few core questions based on problems identified in the present with our current understandings of child welfare and protection histories. While recognising the limitations of this study and the need for broader analysis of the wider context surrounding child welfare practice at the moment, it is argued that some salient conclusions can be drawn about continuity and discontinuity in practice which are of interest to practitioners and students of child welfare social work.

Telling stories of 21st Century welfare: the UK Coalition Government and the neo-liberal discourse of worklessness and dependency’ Critical Social Policy

Policy documents are a useful source for understanding the privileging of particular ideological and policy preferences (Scrase and Ockwell, 2010) and how the language and imagery may help to construct society’s assumptions, values and beliefs. This article examines how the UK Coalition government’s 2010 Green Paper, 21st Century Welfare, and the White Paper, Universal Credit: Welfare that Works, assist in constructing a discourse about social security that favours a renewal and deepening of neo-liberalization in the context of threats to its hegemony. The documents marginalize the structural aspects of persistent unemployment and poverty by transforming these into individual pathologies of benefit dependency and worklessness. The consequence is that familiar neo-liberal policy measures favouring the intensification of punitive conditionality and economic rationality can be portrayed as new and innovative solutions to address Britain’s supposedly broken society and restore economic competitiveness.

Child Welfare as Child Protection Then and Now: What Social Workers Did and Continue to Do

The research reported here builds on the work of one of the authors who, some thirteen years ago, in a similar study, examined the potential for social workers to shift from a child protection to a child welfare practice orientation. As with the original research study, this present project seeks to examine the everyday practices of social workers with children and families as revealed by file analysis, vignette questionnaires (reported here) and interviews with families and social workers (to be reported). A twenty-item vignette questionnaire was completed by fifty-five social workers (65.5 per cent response rate). It was found that there was little agreement on coding decisions with regard to which cases should be designated child protection or child welfare. Further analysis revealed that, regardless of such coding decisions, families tended to receive similar responses by social workers. The results demonstrate that, whilst there has been a reduction in the headline numbers of child protection investigations undertaken across Health and Social Care Trusts in Northern Ireland, the everyday patterns of practice with families and children where parenting concerns remain evident reflect child protection risk management priorities and practices.